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Age and sex distribution of patients
Source publication
Background
Noma (cancrum oris) remains the scourge of children and the “face of poverty” in Sub-Saharan Africa. Recent data on the burden of noma and its risk factors are needed for evaluating and redesigning interventions for its prevention and control.
Objectives
This study aimed to determine the pattern of noma and its risk factors in Northwest...
Context in source publication
Context 1
... hundred and fifty-nine (8.3%) of the 1923 patients admitted into the hospital from January 1999 to December 2011 had fresh noma (with or without the complications of the disease). The ages of the patients ranged from 1 to 32 years (mean = 3.0 ± 1.4), but majority of them, 139 (87.4%) were aged 1-5 years and were females (55.3%) as shown in Table 1. ...
Similar publications
Background:
Noma is a rapidly progressing infection of the oral cavity frequently resulting in severe facial disfigurement. We present a case series of noma patients surgically treated in northwest Nigeria.
Methods:
A retrospective analysis of routinely collected data (demographics, diagnosis and surgical procedures undergone) and in-person foll...
Citations
... After title and abstract scanning, 12 articles were considered relevant. The full manuscripts were reviewed for inclusion [48][49][50][51][52][53][54][55][56][57][58][59] and the extracted data are shown in Tables 1 and 2. ...
... Out of the 12 studies, five (41.7%) obtained their data from the northern states of Nigeria [48,49,[52][53][54], and six (50.0%) collected data from the southern states only [51,[56][57][58][59]. One study (8.3%) separately presented data for the northern and southern regions within a single report [55]. ...
... Every study included in the analysis presented information either about Noma prevalence or its estimation. One study [56] reported the case fatality rates, and five studies examined the associated risk factors [48,49,51,57,59]. Additionally, one study offered insights into the staging of Noma [56], while another provided information on the prevalence for participants aged under 5 years and those aged between 6 and 16 years [53]. ...
Objectives
To determine the prevalence, case-fatality rate, and associated risk-factors of Noma in children in Nigeria.
Methods
Search was conducted in PubMed, Google Scholar, and Cochrane Library databases. Data were extraction using a double-blind approach. Discrepancies were resolved by a third reviewer. Heterogeneity was evaluated using I² statistics. Random-effects model was used for the meta-analysis and subgroup analysis was conducted. The study quality was evaluated using standard Critical-Appraisal-Checklist.
Results
Of the 1652 articles identified, 12 studies that met the inclusion criteria included 871 cases of Noma. Two studies had high-risk of bias and were excluded in the meta-analysis. Pooled prevalence of Noma was 2.95% (95%CI:2.19–3.71; Z = 7.60; p < 0.00001, I²:100.0). Case fatality was reported in one study. Sex-distribution had a male-to-female ratio of 1.1:1. Malnutrition (88.42%, 95%CI:52.84–124.00; I²:100.0), measles (40.60%; 95% CI:31.56–49.65; I²:100.0) and malaria (30.75%; 95% CI:30.06–31.45; I²:100.0) were the most notable associated risk-factors. Prevalence of Noma was non-significantly lower in southern (1.96%,95%CI:1.49–2.44;6 studies) than in northern (4.43%; 95%CI:-0.98-9.83; 4 studies) Nigeria. One study reported the prevalence of Noma in children younger than 5 years.
Conclusions
About every 3 in 100 children in Nigeria had Noma and the prevalence was non-significantly higher in northern than southern Nigeria. Malnutrition, measles, and malaria were major associated risk-factors. Case-fatality rate and prevalence based on different age-groups were inconclusive.
... Most cases are reported from sub-Saharan countries (Table 1), particularly Nigeria, Niger, Burkina Faso, and Senegal, which is not surprising given the prevailing economic crises in many of these countries [12,23]. In particular, the main risk factors of the disease in most African countries include malnutrition, poor oral hygiene, and debilitating infectious diseases such as human immunodeficiency virus (HIV) infection, measles, and other childhood diseases, as infections and malnutrition are known to compromise the immune system, and they have become the common denominator for the occurrence of noma in Sub-Saharan Africa [31]. The prevention and treatment of the disease are not a priority in the African countries where the disease is prevalent [29]. ...
Noma is an overwhelming orofacial necrotizing disease and most cases occur in malnourished people, especially children. It is most common in tropical and subtropical regions of sub-Saharan Africa. Its high death rate, serious physical and psychological morbidity, stigmatization, and social discrimination are all contributing factors. Common public health interventions could prevent, control, and even eradicate noma. However, it is often disregarded when it comes to public health awareness, in-depth scientific research, and funding for prevention, treatment, and research. Noma was added to the list of neglected tropical diseases (NTDs) on December 15, 2023, as it satisfies all WHO criteria for this classification. This paper aims to provide an updated global health review on noma in Africa to reduce its burden on the continent. Healthcare professionals need to be more knowledgeable about noma, and systematic worldwide data collection and documentation regarding noma need to be encouraged to keep track of and eradicate the disease in Africa.
... The aetiology of noma is unknown but thought to be multifactorial [1]. Risk factors for noma include poverty, poor oral hygiene, poor access to routine childhood vaccinations, limited access to quality health care and immunosuppression resulting from comorbidities such as malnutrition, measles and HIV [1,[8][9][10][11][12][13][14][15][16][17]. Malnutrition is frequently listed as a risk factor for noma, however, evidence supporting this theory is largely based on case reports and case series [12,[18][19][20][21][22][23][24][25][26][27][28] and a handful of primary studies [8][9][10][11][29][30][31]. ...
... Risk factors for noma include poverty, poor oral hygiene, poor access to routine childhood vaccinations, limited access to quality health care and immunosuppression resulting from comorbidities such as malnutrition, measles and HIV [1,[8][9][10][11][12][13][14][15][16][17]. Malnutrition is frequently listed as a risk factor for noma, however, evidence supporting this theory is largely based on case reports and case series [12,[18][19][20][21][22][23][24][25][26][27][28] and a handful of primary studies [8][9][10][11][29][30][31]. The epidemiology of the disease is also not well understood. ...
... We assessed risk factors for simple gingivitis using univariate logistic regression (patient age, wealth score, ITFC admission status, if the child was sick during the past 3 months, parent primary caretaker, if child had been given colostrum at birth, if the child eats pap, if the child was vaccinated, SAM, MAM and GAM status upon admission, measles, and malaria diagnoses). These variables were selected as they are reported risk factors for noma [1,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. We conducted an exploratory analysis of risk factors for acute necrotizing gingivitis; proportions are reported. ...
Introduction
Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children.
Methods
We conducted a prospective observational study from 1 st June to 24 th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral exams at admission and discharge.
Findings
Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5–4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1–2.6%) (p = 0.008). Risk factors identified for having simple gingivitis include being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77–6.5; 7 to 12 yrs OR 5.0, CI 1.7–14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22–3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition.
Conclusion
Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis The lack of access to and uptake of oral health care indicates a strong need for oral exams to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
... Nigeria is a country situated in the sub-Saharan African region with millions of households living in abject poverty [13,14], with several nonreported acute cases of noma [15]. Although the national prevalence and incidence rates of noma in Nigeria cannot be accurately established due to limited data, a regional research report showed that the period prevalence of noma in northcentral Nigeria is 1.6 per 100,000 population at risk [16]. ...
Noma is an orofacial gangrenous infection commonly affecting malnourished children in the tropical region of the World, particularly the sub-Saharan Africa. Nigeria is a sub-Saharan African country which is among the countries seriously affected by noma. In Nigeria, noma has been classified as a priority disease. However, only very little attention has been focused on noma research in Nigeria, unlike many other priority diseases. This study conducted an informetric analysis of research outputs on noma in Nigeria, using the PubMed database – a world leading and authoritative database of medical literature. This study revealed that only 26 PubMed-indexed publications on noma (PONs), published between January 1990 and September 2021, were available. A trend analysis of these PONs showed that the average output (outputs from 1999 – 2020 = 23) rate per year (from 1990 to 2020 [31 years]) was 0.74 (23/31). Sokoto (n=11), Oyo (n=4) and Kebbi (n=3) were the top three Nigerian states surveyed on noma in the included PONs. Only 12 publications had international co-authors, of which only few publications had co-authors affiliated to institutions in other African countries: South Africa – 5 publications; and Rwanda – 2 publications. Only 2 publications were funded. Also, the top 5 prolific Nigerian authors on noma in Nigeria were affiliated to Noma Children Hospital, Sokoto State, Nigeria. In conclusion, PONs by Nigerian authors is so meagre in quantity. This low output is an issue of medical concern. More research focused on noma in Nigeria is needed through funding and other research capacity strengthening measures.
... There was female predilection in this series, which agrees with other studies [3,7]. All patients are within the previously reported age of noma occurrence [7,8]. Age and sex may not be an important factor in determining the severity of noma destruction of orbital bone causing blindness. ...
Background: Noma is an infectious disease that rapidly destroys orofacial tissues and neighboring structures in its fulminating course. This study aimed to present a case series of blindness as a result of Noma destruction of the orbital bone and highlight the important aspect of its management. Patients and methods: This was a case series of 12 patients seen and managed for Noma with associated blindness over 2 years study period at Noma Children Hospital Sokoto, Northwest Nigeria. Sociodemographic variables, presenting complaints, presenting visual acuity, investigations, and, the treatment done was recorded. Data were analyzed using IBM SPSS version 25. Result: There were 4 (33.3%) males and, 8 (66.7%) females in the age range of 4-15 years with a mean±SD of 7.5±3.3years. The time range of onset before presentation to our facility was 2 weeks to 4 months. Ophthalmic examination revealed a destroyed globe and purulent discharge with no light perception in all the patients. Anemia and malnutrition were present and, microbiological culture and sensitivity (MCS) yielded no growth in all the patients. Patients were optimized, then later had sequestrectomy and, teeth extraction. Monitoring of patients was done until symptoms resolution. Conclusion: Noma is capable of spreading rapidly to the orbit, causing loss of vision as a complication. However, aggressive medical and surgical intervention in consultation with an ophthalmologist can result in early resolution of symptoms and prevent further spread that may lead to blindness.
... There was female predilection in this series, which agrees with other studies [3,7]. All patients are within the previously reported age of noma occurrence [7,8]. Age and sex may not be an important factor in determining the severity of noma destruction of orbital bone causing blindness. ...
... There was female predilection in this series, which agrees with other studies [3,7]. All patients are within the previously reported age of noma occurrence [7,8]. Age and sex may not be an important factor in determining the severity of noma destruction of orbital bone causing blindness. ...
... Between the 16th and 18th centuries AD, reports of Noma became more frequent and precise throughout Europe, and the usual conservative treatment of simple rinses and pulling loose teeth was increasingly supplemented by newly developed surgical methods [2]. In the wake of improved hygiene, socioeconomic status, and nutritional conditions in much of the increasingly industrialized societies in the 19th and 20th centuries AD, Noma almost completely disappeared in the more developed regions, except for notable recurrences during the two world wars and especially in prisoner-of-war and concentration camps and, more recently, in immunocompromised patients [6,7]. From the historical excerpt, it is clear that Noma is not an NTD per se but rather a neglected disease [8]. ...
... The low level of education of the patients coupled with extreme poverty, poor nutrition, and poor personal and environmental hygiene magnifies the risk of acquisition of the disease. 2,5,[16][17][18][19] The settings in which the patients with noma were found demonstrates the association of the disease with poor nutritional status, poverty, low levels of education, and poor oral and environmental hygiene, as established in previous studies. 2,5,[16][17][18][19] Most of the patients affected consumed predominantly carbohydrate-based food, suggesting that most experience protein malnutrition, which ultimately lowers the immune status. ...
... 2,5,[16][17][18][19] The settings in which the patients with noma were found demonstrates the association of the disease with poor nutritional status, poverty, low levels of education, and poor oral and environmental hygiene, as established in previous studies. 2,5,[16][17][18][19] Most of the patients affected consumed predominantly carbohydrate-based food, suggesting that most experience protein malnutrition, which ultimately lowers the immune status. 5,7,16,20,21 In the context of poor oral hygiene practices, there could be proliferation of oral flora, which may capitalize on the opportunities of likely mucosal abrasions resulting from inflammation and use of such materials as coal to invade the tissues of the mouth and set up rapidly spreading necrotic lesions. ...
... 2,5,[16][17][18][19] Most of the patients affected consumed predominantly carbohydrate-based food, suggesting that most experience protein malnutrition, which ultimately lowers the immune status. 5,7,16,20,21 In the context of poor oral hygiene practices, there could be proliferation of oral flora, which may capitalize on the opportunities of likely mucosal abrasions resulting from inflammation and use of such materials as coal to invade the tissues of the mouth and set up rapidly spreading necrotic lesions. Although the true pathogens associated with noma remain unknown, it is most likely that members of the oral flora play significant roles in the pathogenesis of the disease. ...
Reports of cases of noma in Nigeria remain scarce despite its known and devastating effects on victims. This report presents a retrospective cross-sectional study based on data regarding on patients with noma encountered incidentally during Oral Health Advocacy Initiative outreach on orofacial diseases across 34 states and the Federal Capital Territory in Nigeria over 10 years (2011-2020), which was aimed at contributing to an understanding of the epidemiology of noma in Nigeria. The data were collated and analyzed, and are presented in frequency distribution tables and charts. A total of 7,195 patients with noma were encountered. The northeastern region had the greatest number of patients (n = 1,785, 24.8%) whereas the southwestern region had the least (n = 196, 2.7%). When aggregated by state, Ondo State had the least number of patients (n = 31, 0.4%) whereas Kano State had the greatest (n = 623, 8.7%). Patient age ranged from 3 to 70 years, with a slight male preponderance (56.9%). This report highlights the fact that noma is prevalent in Nigeria but remains neglected, with extensive but preventable physical, emotional, and social debilitation and devastation of the victims across all age groups. There is a need for a more robust survey to determine the true burden of the disease. There is also an urgent need for collaboration between governments and nongovernmental organizations to institute appropriate interventions by way of public education and enlightenment, as well as case detection and early treatment to mitigate the devastating consequences of delayed or poorly managed cases.
... Among the Noma cases involved in a hospital-based retrospective study in north-western Nigeria, 84.3% had manifest outer and inner cheek layer lesions. The study examined 1923 patients admitted to the hospital from January 1999 to December 2011 [31]. Another study, which assessed the outcomes at 18 months of 37 surgically treated Noma cases at the Noma Children's Hospital, Sokoto, Nigeria revealed 36.0% of outer cheek involvement among the studied population [32]. ...
Introduction:
Noma is a disfiguring gangrenous disease of the orofacial tissue and predominantly affects malnourished children. The tissue gangrene or necrosis starts in the mouth and eventually spreads intra-orally with the destruction of soft and hard tissues. If not controlled, the natural course of the condition leads to a perforation through the skin of the face, creating a severe cosmetic and functional defect, which often affects the mid-facial structures. Furthermore, the course of the disease is fulminating, and without timely intervention, it is fatal.
Materials and methods:
A retrospective clinical cross-sectional study was conducted to assess the sequela and severity of Noma in Ethiopia. Medical records of patients diagnosed with Noma were reviewed. The medical files were obtained from Yekatik 12 Hospital, Facing Africa, and the Harar project,-the three major Noma treatment centers in Ethiopia. The severity of facial tissue damage and the extent of mouth trismus (ankylosis) were examined based on the NOIPTUS score.
Results:
A total of 163 medical records were reviewed. Of those, 52% (n = 85) and 48% (n = 78) have reported left-sided and right-sided facial defects, respectively. The facial defects ranged from minor to severe tissue damage. In other words, 42.3% (n = 69), 30.7% (n = 50), 19% (n = 31), and 8% (n = 13) have reported Grade-2 (25-50%), Grade-3 (50-75%), Grade-1 (0-25%), and Grade-4 (75-100%) tissue damages respectively. Cheek, upper lip, lower lip, nose, hard palate, maxilla, oral commissure, zygoma, infra-orbital region, mandible, and chin are oftentimes the major facial anatomic regions affected by the disease in the individuals identified in our review. Complete loss of upper lip, lower lip, and nose were also identified as a sequela of Noma.
Discussion:
The mortality rate of Noma is reported to vary between 85% and 90%. The few survivors suffer from disfigurement and functional impairment affecting speech, breathing, mastication, and/or even leading to changes in vision. Often, the aesthetic damage becomes a source of stigma, leading to isolation from society, as well as one's family. Similarly, our review found a high level of facial tissue damage and psychiatric morbidity.
